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How a clinical audit works in the NHS, step by step

By the Health Job Scout team · 5 min read · Fact-checked 26 October 2026

Sooner or later every NHS doctor is asked about audit. It comes up on applications, at interview and at your annual appraisal, and the first time you run one it can be confusing, especially if you are an international medical graduate and audit worked differently where you trained. This guide explains how a clinical audit runs in the NHS, stage by stage, using the best practice guide from the Healthcare Quality Improvement Partnership (HQIP). It explains the process only. It does not list topic ideas.

What a clinical audit is

A clinical audit asks one question: are we doing what we agreed we should be doing? You pick a standard, measure real practice against it, and see where the gap is. If there is a gap, the team agrees a change, and you measure again later to find out whether the change worked. HQIP calls clinical audit a quality improvement activity and sets it out as a cycle of four stages. We follow those four below. Not sure whether your project is an audit, a quality improvement project or research? Our guide to audit vs quality improvement vs research explains the difference.

It is not research. Audit measures current practice against standards that already exist. Research tries to find out something new. HQIP's guide to ethical issues notes that the line between the two can be hard to draw, which is one more reason to talk to your audit department before you start.

Stage 1: Preparation and planning

Everything later depends on this stage. HQIP's criteria for it come down to a few things:

• The topic should be something that can actually be improved, and audit should be the right method for it.
• The audit needs a clear aim and clear objectives.
• The standards you measure against should be based on the best available evidence, and referenced. For example, national guidance or a royal college standard.
• A named clinician leads it. HQIP says that if the lead is a junior doctor on rotation, a more senior clinician should oversee the project so that it is finished.
• It follows your trust's local rules for proposing, registering, carrying out and reporting audits.
• It follows the law on information governance and data protection, including how you choose the sample and handle the data.
• The team whose work is being audited knows about it from the start.

Stage 2: Measuring performance

Now you collect the data. Work out what you need from the standards themselves, and collect nothing you do not need to measure them. HQIP says the same. Use a data collection form that has been designed for the job and tried out on a few cases before full collection starts. If several people will collect data, write a short protocol so that everyone reads the notes in the same way.

Ask your audit department which details you are allowed to record about patients, and whether patients should be identified by a code rather than by name.

Stage 3: Implementing change

Share the results with the team. Where practice falls short of a standard, the next job is to find out why, using a method such as root cause analysis. Once the causes are clear, the team writes an action plan, gets it signed off under local governance, puts it into practice and keeps an eye on the effect. HQIP also asks you to watch for unintended harm from the change.

Stage 4: Sustaining improvement

HQIP says the audit cycle is not complete until you have evidence that the action plan improved the service. That is why the second round of data collection, the re-audit, matters. The team decides whether and when to repeat the audit, and whether the form needs refining. The results, including what happened after the changes, should be written up and shared with colleagues.

If you are an overseas doctor new to the NHS

• Find the audit or clinical effectiveness team at your hospital early. They know the local forms and the order things have to happen in.
• Ask who your senior clinical lead can be before you plan anything else.
• Do not record more patient information than you need. If you are unsure whether something counts as identifiable, ask before you collect it.
• If you are on a clinical attachment, see our guide on whether attachments count as NHS experience, then ask the department there whether an audit could be registered with you in it.
• Describe your role honestly. If you collected data for a team audit, say that. Our guide to why honesty matters explains why.

Common gaps to check before you start

• The standard is vague or has no source.
• The data form collects far more than the standards need.
• Nobody registered the audit, so the hospital will not recognise it.
• The project stops after the results and never reaches an action plan or a re-audit.

The Audit toolkit

If you would like the documents ready-made, we offer the Audit toolkit: nine documents and a spreadsheet for one audit topic. You still run the audit and collect the data yourself. The Audit toolkit page lists what is included and the price.

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